G. Muthupackiam v. Zonal Manager, Life Insurance Corporation of India
2012-01-31
T.RAJA
body2012
DigiLaw.ai
JUDGMENT 1. The petitioner seeks for issuance of a writ of certiorarified mandamus to quash the order passed by the second respondent, dated 30.03.2007, relating to LIC policy No.321586863, dated 15.05.2004, issued by the branch-Unit-I, LIC of India, LIC Buildings, Trivandrum Road, Nagercoil, and consequently, to direct the respondents to pass suitable order for payment of claim amount to the petitioner under the above said policy. 2. The petitioner's son-P. Thanga Murugan was a doctor. After completing his Higher Secondary Course in March, 1994, with good academic records, joined medical course in Tirunelveli Medical College. He also successfully completed the course in December, 2000. After completing the course, he joined as a Casuality Medical Officer in Dr.Kumarasamy Health Centre in Perumalpuram of Kanyakumari District. Thereafter, he joined as a Resident Medical Officer in Moris Mathyas Hospital, Nagercoil. During 2004, the petitioner's son took a policy for a sum of Rs.5,00,000/-under Policy No.321586863, dated 15.05.2004. The petitioner was nominated as nominee for the above said policy. At the time of taking policy, the respondent corporation also made the necessary check up and verification with the panel doctors and on full satisfaction of the particulars given, the LIC policy was given and thereupon, he was paying the premium as per the policy. Subsequently, he got married on 27.11.2005. In the month of January, 2006, he complained of back pain and for which, he got initial treatment at Moris Mathias Hospital, Nagercoil, where he was working, and then at Appollo Hospital, Madurai. In the medical test, it was diagnosed that it is a case of Multiple Myloma, a symptom of cancer. Therefore, it was referred to Regional Cancer Centre, Trivandrum. But, in spite of intensive treatment given to him, he died on 06.09.2006. After the death of her son, the petitioner, being a nominee of the said policy, made a claim to the respondent corporation in October, 2006, for payment of the amount due under the policy. But, the second respondent, by a communication dated 30.03.2007, by repudiating the liability, rejected her claim. Aggrieved by the said order, the petitioner has filed the present writ petition with the aforesaid prayer. 3. Learned counsel appearing for the petitioner submitted that, under Section 45 of the Insurance Act, 1938, the respondent Corporation cannot question the liability under the policy and repudiate the claim of insurance benefits.
Aggrieved by the said order, the petitioner has filed the present writ petition with the aforesaid prayer. 3. Learned counsel appearing for the petitioner submitted that, under Section 45 of the Insurance Act, 1938, the respondent Corporation cannot question the liability under the policy and repudiate the claim of insurance benefits. Mere allegation of suppression of some treatment taken by the petitioner's son long back during the age of 13 has no relevance to the cause of death and the same cannot be accepted now to repudiate the liability. Therefore, when Section 45 of the Act, categorically mentioned that a policy cannot be questioned after a period of two years, the respondent corporation cannot repudiate after two years i.e., in the year of 2007, when the policy was issued on 15.05.2004. 4. Further, it was submitted that temporary mental stress or depression cannot be taken as disease. The policy holder has given the necessary particulars and materials at the time of taking the policy and that has been verified and checked by the panel of doctors. Hence, it was contended that the stand now taken by the respondents cannot be sustained. On that basis, he prayed for allowing the present writ petition. 5. In reply, learned counsel appearing for the respondents contended that when the policy was taken on 15.05.2004, after expiry of one year, the same was revived on 05.11.2005. But, the policy holder, both at the time of taking policy and also at the time of revival, had suppressed the factum of his disease. The medical records of the policy holder would show that the Life Assured had past history of seizures since childhood and was under medication for bipolar disorder and was on anti depressants. Similarly, medical records of the Assured at Ram Hospital, Psychiatry Hospital and Institute, Anna Nagar, Madurai, would show that the Life Assured had taken treatment from 24.08.1991 to 13.02.1993, for poor concentration, fatigue, unable to study, disturbed sleep and jerky movements of limps.
Similarly, medical records of the Assured at Ram Hospital, Psychiatry Hospital and Institute, Anna Nagar, Madurai, would show that the Life Assured had taken treatment from 24.08.1991 to 13.02.1993, for poor concentration, fatigue, unable to study, disturbed sleep and jerky movements of limps. Further, it was submitted that the Life Assured had taken treatment after the revival of the policy in Appollo Speciallity Hospital, Madurai, from 01.01.2006 to 15.01.2006, for multiple lesions – Bone, intractive lung lesion, Diabetes inspidus – pituitay infiltation and mangancy secondary carcino matous deposti and Regional Cancer Centre, Trivandrum, from 18.01.2006 to 15.02.2006, for metastatic carcinoma – unkonw primary – Bipolar mental disease Diabetes and Inspidus and Thiraviam Orthopedic Hospital, Nagercoil, on 16.12.2005, for T.B. Spine and metastatic problem. The discharge summary of the hospital shows that Life Assured had the symptoms of the above diseases 2 ½ months prior to 01.01.2006. However, since there has been a disputed facts involve in the present writ petition, this Court, sitting under Article 226, cannot go into the disputed question of facts. On that basis, he prayed for dismissal of the present writ petition. 6. Heard the learned counsel appearing on either side and perused the materials available on record. 7. The petitioner's son-policy holder has taken a policy on 15.05.2004. At the time of taking policy, he was a qualified doctor. The petitioner was nominated for the said policy. At the time of taking policy, he has given the requisite information and thereafter, the respondent corporation had also made necessary check up and verification of his health with the panel doctors and only after satisfying with the particulars given by him, the policy No.321586863, dated 15.05.2004, was issued to him. 8. It is also to be remembered that when he was 13 years of age and studying 10th standard in school, he had some mental strain, and after taking necessary medicines prescribed by the doctor, he became alright and he was selected on merit for M.B.B.S. Course and after completing the course, he became a doctor. Even in the counter, it has been mentioned that the records of the Policy Holder collected from the Regional Cancer Centre, Trivandrum, has shown that the deceased had a past history of seizures since childhood and was under medication for Bipolar disease and was a known case of Bipolar disorder.
Even in the counter, it has been mentioned that the records of the Policy Holder collected from the Regional Cancer Centre, Trivandrum, has shown that the deceased had a past history of seizures since childhood and was under medication for Bipolar disease and was a known case of Bipolar disorder. These particulars also go to show that the policy holder, as admitted in the affidavit, while he was studying 10th standard in school when he was 13 years of age, had some mental strain and after taking necessary medicines prescribed by the doctor, he became alright. Even he has also completed M.B.B.S. Course and after completing the same, he became a doctor in 2002. After two years, in the year 2004, he took a policy. Till the date he took the insurance policy, it is not the case of the respondents that the policy holder had the symptoms of cancer. Besides, that policy also lapsed from 15.05.2005 and again, the insurance company revived the policy on 05.11.2005. Here, it is more relevant to remember a vital fact in mind that if the policy holder, at the time of taking police on 15.05.2004, knew that he was affected with cancer, certainly, would not have allowed the policy to lapse from 15.05.2005. However, the policy was revived on 05.11.2005. Even, at the time of revival of the insurance policy, it is not the case of the respondent that the policy holder had cancer but somehow he had concealed the same, therefore, it is not open to the respondent insurance company to repudiate after the death of the policy holder on the ground that he had concealed the disease, when he took the original policy on 15.05.2004. 9.
9. In this context, it is useful to extract Section 45 of the Insurance Act, which is extracted hereunder:- "No policy of insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy holder and that the policy-holder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose ...." 10. Further, the three conditions for the application of the second part of Section 45 are :-- "1.) the statement must be on a material matter or must suppress facts which it was material to disclose; 2.) the suppression must be fraudulently made by the policy-holder; and 3.) the policy-holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclosed." The above reading of Section 45 of the Act goes to show that if a period of two years has expired from the date on which the policy of life insurance was effected, that policy cannot be called in question by an insurer on the ground that a statement in the proposal for insurance or in any report of a medical officer or referee, or a friend of the insured, or in any other document leading to the issue of the police, was inaccurate or false. 11. In the present case, the petitioner's son unfortunately died out of cancer on 06.09.2006.
11. In the present case, the petitioner's son unfortunately died out of cancer on 06.09.2006. When there was no allegation that there was a symptom of cancer before taking policy or before even renewing his policy, the repudiation beyond the period of two years, is not in order, therefore, the policy cannot be called in question beyond the period of two years from the date on which it was effected. Further, there are facts that the deceased had been taking medicines and injections would not be sufficient to invalidate the policy. There are many persons with varying degrees of hypochondria, who imagine they are suffering from all sorts of disease and go on taking medicines whether they are necessary or not, therefore, they cannot be said to be suffering from any ailment or to be receiving any treatment for any ailment and in such cases, the policy cannot be avoided merely by referring to the fact that they had been taking some medicines. 12. In the case of Kalyanai Achi v. Life Insurance Corporation of India (1979 Mad LW 662), this Court has held that there must be satisfactory proof that the assured was suffering from ailments, which means there must be proof of proper diagnosis and there must also be further proof that the doctor had communicated to the assured that he was suffering from particular disease or the assured himself knew that he was suffering from those ailments and that it is only if such knowledge is made out that question of a failure to disclose at all would arise. But, in the present case, as I already mentioned above, there is no proof that the assured was suffering from any ailment at the time of taking policy or at the time of revival of policy. In fact, the panel doctors also, after thorough check up of the policy holder, issued the policy on 15.05.2004, under policy No.321586863. Had the policy holder knew about his disease, he would not have revived his policy. 13. Further, it is a common knowledge that when the Corporation grants a policy of high bonus and maturity value, it normally insists even for Eco-Cardiogram along with other medical check-up of the insured after which if the policy is issued, it will have to be presumed that the authorised Doctor of the Corporation has cross checked the information furnished by the insured.
If this requirement is not followed by the Corporation, it has only to blame itself and not the insured, for, if this were not the right course and the Corporation is allowed to raise a plea of this nature after the death of the insured, the whole purpose of taking the insurance policy itself will get frustrated, which would not only be against equity and justice, but also against the principle of contractual obligation, since the contracting parties are expected to enter into a contract after fully understanding the pros and cons and its Implication, and also to bear the consequence in case of any lapse. The nature of transaction between the Insurance Companies with the insured is clearly in the nature of proposal and acceptance, which gives rise to contractual obligation after the proposal is signed and accepted by the Corporation after which the policy is issued and once that process is complete neither of the contracting parties can be permitted to raise a plea that the contract was void after its execution. This being the well acknowledged legal position, the insurance company cannot be permitted to raise a plea that the deceased insured had not disclosed about his illness at the time of taking the policy, when it was also duty of the Insurance Company to verify the correctness of the information furnished by the insured. This duty of the Insurance Company is akin to the obligation of the insured, who is legally bound to pay the insurance premium regularly and well within time and in the event of failure to do so, the Insurance Company may refuse to pay the maturity amount, therefore, the Corporation cannot be permitted to raise a plea regarding non-furnishing of information to the Corporation after the death of the insured. 14. For the foregoing reasons, the impugned order passed by the second respondent is set aside. The respondents are directed to pay the insured amount as expeditiously as possible to the nominee, namely, the petitioner herein. 15. In the upshot, the writ petition is allowed. No Costs.